The relationship between payer type and lipid outcomes in response to clinical lifestyle interventions in youth with dyslipidemia

• Published in: BMC pediatrics 2019-07, Vol.19 (1), p.217-217, Article 217
• Main Authors: Hartz, Jacob C, Yellen, Elizabeth, Baker, Annette, Zachariah, Justin, Ryan, Heather, Griggs, S Skylar, K Desai, Nirav, Yanumula, Ravi, Vinci, Samuel, Brantley, Caroline, Bachman, Jennifer, McAuliffe, Ellen, Gauvreau, Kimberlee, Mendelson, Michael, de Ferranti, Sarah
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent obesity; Age Factors; Body Mass Index; Cardiology; Cardiovascular diseases; Child; Children and adolescents; Cholesterol; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Corporate sponsorship; Demographic aspects; Dyslipidemia; Dyslipidemias; Dyslipidemias - blood; Dyslipidemias - ethnology; Female; Financing, Government; Health; Health counseling; Health insurance; Health insurance industry; Humans; Influence; Insurance; Insurance, Health, Reimbursement - classification; Life Style; Lifestyle interventions; Lipids - blood; Low density lipoproteins; Male; Massachusetts - epidemiology; Obesity; Patient outcomes; Pediatric diseases; Pediatric Obesity - blood; Pediatric Obesity - epidemiology; Pediatric Obesity - ethnology; Private Sector; Prospective Studies; Regression Analysis; Sex Factors; Social class; Triglycerides; Triglycerides - blood; White People; Young Adult; Youth
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-019-1593-5

Payer-type (government-sponsored health coverage versus private health insurance) has been shown to influence a variety of cardiovascular disease outcomes in adults. However, it is unclear if the payer-type impacts the response to a lifestyle intervention in children with dyslipidemia. We analyzed data prospectively collected from patients under the age of 25 years who were referred to a large regional preventive cardiology clinic from 2010 to 2016 in Massachusetts. We compared baseline high density lipoprotein cholesterol (HDL-C), triglycerides (TG), non-HDL-C, and low density lipoprotein cholesterol (LDL-C) by payer-type. Further, we analyzed the change in lipid values in response to a clinic-based multidisciplinary intervention over a nearly six-year period by payer-type with multi-variable adjusted linear regression models. We also tested for effect modifications by age, sex, race, and body mass index (BMI) category. Of the 1739 eligible patients (mean age 13 years, 52% female, 60% overweight and obese, 59% White), we found that patients with government-sponsored coverage (n = 354, 20%) presented to referral lipid clinic with lower HDL-C (- 3.5 mg/dL [1.0], p